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Urinary > Lecture 21 - Carcinoma Of The Prostate > Flashcards

Lecture 21 - Carcinoma Of The Prostate Flashcards

1
Q

What is PSA?

A

Prostate specific antigen

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2
Q

What is the most common cancer in. Men?

A

Prostate cancer

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3
Q

What is the normal age range of developing prostate cancer?

A

Over 50

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4
Q

What are the risk factors for prostate cancer?

A

Increased age
Family history (BRACA2 gene mutation)
Ethnicity (Black and Asian)

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5
Q

What does a BRACA2 gene mutation increase the risk of in women?

A

Breast cancer

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6
Q

What are the 2 main zones of the prostate?

A

Peripheral zone (posterior part)
Transitional zone (more central)

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7
Q

What part of the prostate does prostate cancer typically affect?

A

Peripheral zone (posterior part)

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8
Q

What zone of the prostate does BPH normally develop in?

A

Transitional zone

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9
Q

What does prostate cancer often metastasise to?

A

Bone (normally the spine causing back pain)

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10
Q

How does prostate cancer typically present?

A

UTI symptoms (urinary symptoms)

Raised PSA

Bone pain

Opportunistic finding from DRE

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11
Q

Why is elevated PSA not diagnostic for prostate cancer?

A

Other prostate issues cause raised PSA

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12
Q

What can cause raised PSA?

A

Prostate cancer
Infection
Prostatitis (inflammation)
Large prostate
Urinary retention

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13
Q

What is opportunistic prostate screening?

A

When a DRE is done and the prostate is enlarged do the PSA test

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14
Q

What is the Gleason classification of prostate cancer?

A

Describes how well differentiate the tumours are

Grade 1 = well differentiated
Grade 5 = anaplastic

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15
Q

How is prostate cancer diagnosed?

A

Digital rectal examination reveals hard and irregular prostate

US see prostatic mass

Inc PSA levels (but if low not indicative of not cancer)

Biopsy of prostate

Radiographs and bone scans

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16
Q

How can a bone scan be used to identify metastasis?

A

Osteoosclerotic lesions have an increaased uptake of the isotope so appear as hotspots on bone scan

17
Q

How do you treat localised prostate cancer?

A

T1/T2 radical surgical resection (prostatectomy) or TURP

Local radiotherapy can be used if patient unfit for surgery

Surveillance (if tumour slow growing)

18
Q

What are the side effects of treating localised prostate cancer via prostatectomy?

A

Urinary incontinence
Erectile dysfunction
Infertility

19
Q

Why can prostatectomy lead to urinary incontinence?

A

Pudendal nerve damage

20
Q

What side effects can radiotherapy cause treating localised prostate cancer?

A

Discomfort around radiotherapy site
Diarrhoea
Loss of pubic hair
Tiredness
Inflammation of bladder lining
erectile dysfunction

21
Q

What is brachytherapy?

A

Type of radiotherapy where the radioactive sees are inserted into the prostate gland to give high dose radiation just tot he prostate to reduce side effects

22
Q

How is advanced prostate cancer treated?

A

Hormonal manipulation since testosterone promotes tumour growth

Surgical castration

Medical castration

Palliative care

23
Q

What enzyme catalyses the conversion of testosterone to its stronger form dihydrotestosterone?

A

5a reductase

24
Q

What are some ways of medical castration?

A

LHRH agonists
GnRH agonists

25
Q

What are the side effects of castration?

A

Reduction of testosterone causes:
-thinning of bones
-dec muscle mass
-inc breast size
-weight gain
—mood changes
-hot flashes

26
Q

What is the prognosis for 5yr survival for T1 prostate cancer tumours?

What about if theres local or metastatic spread?

A

T1 = 75-90%

Local or metastatic = 30 - 45%

27
Q

What is the median sulcus of the prostate?

A

Line between the 2 lobes of the prostate

28
Q

How should a healthy prostate feel?

A

Soft with give

29
Q

How does the prostate feel with BPH?

A

Firm + enlarged

30
Q

How does a prostate carcinoma feel?

A

Cant feel distinct lobes

Lumps and bumps

31
Q

What are some differential diagnoses:

65yr male
Hesitancy + nocturia
Weight loss
Lower back pain but no injury

A

BPH
Metastatic prostate cancer
Prostatitis
Urethral strictures

32
Q

What does elevated PSA indicate?

A

Prostate issue

33
Q

What are the signs of urinary obstruction?

A

Hesitancy
Haematuria
Cant pass urine
Flank or abdominal pain

34
Q

How is T2 prostatic cancer treated?

A

Surgical removal of prostate

Radiotherapy

Urinary (24 decks)

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